National Institutes of Health (NIH) National Cholesterol Education Program (NCEP) Therapeutic Lifestyle Changes (TLC) Diet

therapeutic diet, the woman’s clinic

Therapeutic diet

TLC Diet—Daily Food Guide—Food Groups

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

To lower your blood cholesterol level, choose only the leanest meats, poultry, fish and shellfish.

Choose chicken and turkey without skin or remove skin before eating.

Some fish, like cod, have less saturated fat than either chicken or meat.

Since even the leanest meat, chicken, fish, and shellfish have saturated fat and cholesterol, limit the total amount you eat to 5 ounces or less per day.


In general, chicken and turkey are low in saturated fat, especially when the skin is removed. When shopping for poultry remember:

You can buy chicken and turkey pieces with the skin already removed. Or buy pieces with the skin on and remove it yourself before eating . . . it’s easy to do. Remember, the white meat itself always contains less saturated fat than the dark meat.

Limit goose and duck. They are high in saturated fat, even with the skin removed.

Try fresh ground turkey or chicken that is made from white meat like the breast.

Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also “lean” beef hot dogs and vegetarian (made with tofu) franks that are low in fat and saturated fat.

Fish and Shellfish

When shopping for fish and shellfish remember that:

Most fish is lower in saturated fat and cholesterol than meat or poultry.

Shellfish varies in cholesterol content. Shellfish have little saturated fat and total fat. Even shrimp can be enjoyed occasionally on the TLC Diet provided you eat less than 200 milligrams of cholesterol a day. For example, 3 ounces of steamed shrimp has 167 milligrams of cholesterol.

You can make changes a little at a time!Try one of the things below. Do it today!

The next time I buy chicken and turkey, I’ll get the skinless kind — or take the skin off myself.

I’ll limit my daily meat servings to the size of two decks of cards.

This week, I’ll try a new type of fresh or plain frozen fish.

Meat Substitute

Dry peas and beans and tofu (bean curd) are great meat substitutes that are low in saturated fat and cholesterol. Dry peas and beans also have a lot of fiber, which can help to lower blood cholesterol. Try adding a ½ cup beans to pasta, soups, casseroles, and vegetable dishes. Tofu takes on the flavor of marinades well. Try marinating tofu in a nonfat dressing or a tangy sauce and grilling or baking for a heart healthy dish.


Egg yolks are high in dietary cholesterol–each contains about 213 milligrams. So, egg yolks are limited to no more than 2 yolks per week. This includes the egg yolks in baked goods and processed foods. Check the label to see how much cholesterol the food contains or ask the bakery if the recipe uses whole eggs. Limit these types of foods for occasional treats.

Egg whites have no cholesterol, and you can substitute them for whole eggs in recipes — two egg whites are equal to one whole egg. You can also use cholesterol-free egg substitute in place of whole eggs – In many baked goods, you can’t tell the difference.

Try one of the things below. Do it today!

I’ll try a cholesterol-free egg substitute instead of whole eggs.

I’ll count the number of eggs I eat a week and see if I meet the recommendations.

Milk, Yogurt, and Cheese Group

Like high fat meats, regular dairy foods that have fat — such as whole and 2% milk, cheese, and ice cream — are also high in saturated fat and cholesterol. However, dairy products are an important source of nutrients. You should eat 2 to 3 servings per day of lowfat or nonfat dairy products. Here is a guide to buying low fat and nonfat dairy foods:

Buy fat free and 1% milk rather than whole or 2% milk. Fat free and 1% milk have just as much or more calcium and other nutrients as whole milk – with much less saturated fat and cholesterol.

Baby Steps: If you now drink whole milk, you will probably find it easier to change to fat free milk in steps so your taste buds can adjust. Drink 2% milk for a few weeks, then 1% milk and finally fat free. You’ll get used to the new taste gradually. And, with each step, you’ll cut down on the saturated fat and cholesterol.


When looking for hard cheeses, go for the versions that are “fat free,” “reduced fat,” “low fat,” or “part skim.” Choose varieties that have 3 grams of fat or less per ounce.

When looking for soft cheeses, choose low fat (1%) or nonfat cottage cheese, farmer cheese, or part-skim or light ricotta. Some of these cheeses have 3 grams of fat or less per ounce.

If you are watching your sodium intake, choose lower sodium cheeses. Read the label to compare the sodium content.

Often when people cut back on meat they eat cheese instead, thinking they are cutting back on saturated fat and cholesterol (not necessarily true)

Frozen Dairy Desserts

Buy frozen desserts that are lower in saturated fat, like ice milk, low fat frozen yogurt, low fat frozen dairy desserts, fruit ices, sorbets, and popsicles.

Other Dairy Foods

Buy low or nonfat yogurt; like many other dairy foods, it is an excellent source of protein and calcium. Eat lowfat or nonfat yogurt alone or as a topping or in recipes. Try topping with fruit.

Try low fat or nonfat sour cream or cream cheese blends. Many taste as rich as the real thing, but have less fat and calories.

Fats and Oils

You can help to lower your blood cholesterol when you replace saturated fats with unsaturated fat. Just be sure to limit the total amount of fats or oils to keep calories in check.

When buying fats and oils, remember to:

Choose liquid vegetable oils that are high in unsaturated fats — like canola, corn, olive, peanut, safflower, sesame, soybean, and sunflower oils.

Buy margarine made with unsaturated liquid vegetable oils as the first ingredient. Choose soft tub or liquid margarine or vegetable oil spreads.

Limit butter, lard, fatback, and solid shortenings. They are high in saturated fat and cholesterol.

Buy light or nonfat mayonnaise and salad dressing instead of the regular kind that are high in fat. For example, two tablespoons of regular Italian dressing can add as many as 14 grams of fat.

Try one of the things below. Do it today!

Instead of using butter to spread on my toast, I’ll switch to a soft tub margarine.

To cut back on fat and calories, I’ll try to use a reduced fat or nonfat salad dressing or mayonnaise or naturally low fat lemon juice, vinegar, or herbs.

A Word about Margarine:

You may have heard that margarine has a type of unsaturated fat called “trans” fat. “Trans” fats raise blood cholesterol more than other unsaturated fats, but not as much as saturated fats. “Trans” fats are formed when vegetable oil is hardened to become margarine or shortening, through a process called “hydrogenation.” The harder the margarine or shortening, the more likely it is to contain more “trans” fat. Margarines that are free of “trans” fats are now available. Read the ingredient label to choose margarine that is “trans” fat free or contains liquid vegetable oil as the first ingredient rather than hydrogenated or partially hydrogenated oil. Use the food label to choose margarine with the least amount of saturated fat

Fruits and Vegetables

You should be eating at least 3 to 5 servings of fruits and vegetables each day. Fruits and vegetables are very low in saturated fat and total fat, and have no cholesterol. A diet high in fruit and vegetables may also help to improve cholesterol levels for those with high cholesterol. So, fruits and vegetables are great substitutes for foods high in saturated fat and cholesterol.

When shopping, remember to:

Buy fruits and vegetables to eat as snacks, desserts, salads, side dishes, and main dishes

Add a variety of vegetables to meat stews or casseroles or make a vegetarian (meatless) main dish.

Wash and cut up raw vegetables (carrot, broccoli, cauliflower, lettuce, etc.) and store in the refrigerator for quick and easy use in cooking or snacking.

Serve fresh fruit for dessert or freeze (banana, berries, melon, grapes) for a delicious frozen treat.

Display fresh fruit in a bowl in the kitchen to make fruit easier to grab as a snack.

To keep naturally low fat vegetables low in fat and saturated fat, season with herbs, spices, lemon juice, vinegar, fat free or lowfat mayonnaise or salad dressing.

Try one of the things below. Do it today!

I’ll make an entree with more vegetables and less meat or make a vegetarian (meatless) meal at least once a week.

If I have a small amount of leftover meat, I’ll make a stew that has lots of vegetables.

I’ll keep more fruit out in a bowl or in the refrigerator so it will be handy for a snack or dessert

Breads, Cereals, Rice, Pasta, and Other Grains

Breads, cereals, rice, pasta, and other grains, and dry beans and peas are generally high in starch and fiber and low in saturated fat and calories. They also have no dietary cholesterol, except for some bakery breads and sweet bread products made with high fat, high cholesterol milk, butter and eggs.

Like fruits and vegetables, naturally low fat, low cholesterol breads and other foods in this group are also good choices. You should be eating 6 to 11 servings of foods from this group each day. If you have high triglycerides and/or low HDL, you should keep your carbohydrate intake below the maximum of 60% of total calories. You can choose a diet up to 35% fat, substituting unsaturated fat for saturated fat.

When buying foods from this group, remember to:

Choose whole grain breads and rolls often. They have more fiber than white breads.

Buy dry cereals, most are low in fat. Limit the high fat granola, muesli, and oat bran types that are made with coconut or coconut oil and nuts, which increases the saturated fat content. Add fat free milk or 1% milk instead of whole or low fat (2% milk) to save saturated fat and cholesterol.

Buy pasta and rice to use as entrees. Hold the high fat sauces (butter, cheese, cream, white).

Limit sweet baked goods that are made with lots of saturated fat, mostly from butter, eggs, and whole milk such as croissants, pastries, muffins, biscuits, butter rolls, and doughnuts. These are also high in cholesterol.

Try one of the things below. Do it today!

For breakfast, instead of doughnuts and muffins, I’ll try a hot or cold cereal with fat free milk or toast and jelly.

I’ll top my spaghetti with lightly stir-fried vegetables instead of meat or a creamy sauce.

Sweets and Snacks

Some sweets and snacks — like baked goods (cakes and cookies) cheese crackers, and some chips — often are high in saturated fat and cholesterol.

Here are some low fat sweets and snacks to buy and use only now-and-then:

Angel food cake topped with fruit puree or fresh fruit slices

Fat free or low fat brownies, cakes, cheesecake, cupcakes, and pastries

Fat free or lowfat cookies like animal crackers, devil’s food cookies, fig and other fruit bars, ginger snaps, and vanilla or lemon wafers

Frozen lowfat or nonfat yogurt, fruit ices, ice milk, sherbet, and sorbet

Gelatin desserts – watch the whipped cream!

Puddings made with 1% or fat free milk

Just remember that, while these treats may be low in fat, most are not low in calories. So choose them only every now-and-then, especially if you are trying to control your weight to improve your blood cholesterol levels.

Try one of the things below

The next time I crave a cookie, I will try a new fat free type (But not too many – remember the calories!)

Instead of buying ice cream, I will try ice milk or nonfat frozen yogurt.

Instead of snacking on regular chips, I’ll try pretzels or butter-free air popped popcorn.

Not all snack foods are high in saturated fat and cholesterol. Buy some of these low fat ones and keep them on hand for snack attacks:

Ready-to-eat cereals without added sugar*

Frozen grapes or banana slices; or other fresh fruit

Fruit leather or other dried fruit

Low fat or fat free crackers* like melba toast, rice cakes, rye crisp, and soda crackers

No-oil baked tortilla chips*

Popcorn (air popped or “light”)*

Raw vegetables with nonfat or low fat dip

*If you are watching your sodium intake, be sure to look for low sodium or unsalted varieties.

Heart Healthy Cooking Tips

Cooking low saturated fat, low cholesterol dishes may not take a long time, but best intentions can be lost with the addition of butter or other added fats at the table. It is important to learn how both certain ingredients and preparation methods can add unwanted saturated fat and cholesterol to your dishes. The following list provides examples of lower fat cooking methods and tips on how to serve dishes low in saturated fat and cholesterol.

These cooking methods tend to produce lower saturated fat levels-

Roast* — for vegetables, skinless chicken, and lean meats ·

Lightly stir-fry or sauté in cooking spray, small amounts of vegetable oil, or reduced sodium broth ·

Grill seafood, chicken or vegetables

*When roasting – place meats on a rack so fat can drip away.

How to Save Saturated Fats and Cholesterol

Look at the following examples for how to save saturated fat and cholesterol when preparing and serving foods. You might be surprised at how easy it is!

Two tablespoons of butter on a baked potato can add an extra 16 grams of saturated fat and 22 grams of fat! However, ¼ cup salsa has 0 grams of saturated fat and no cholesterol!

Two tablespoons of regular creamy Italian salad dressing will add an extra 3 grams of saturated fat and 18 grams of fat. Reduced fat Italian dressing adds no saturated fat and only and 2 grams of fat!

Try These Fat Flavorings—Add during cooking or at the table

Herbs – oregano, basil, cilantro, thyme, parsley, sage, rosemary

Spices – cinnamon, nutmeg, pepper, paprika

Reduced fat or nonfat salad dressing

Reduced fat or nonfat mayonnaise

Reduced fat or nonfat sour cream

Reduced fat or nonfat yogurt

Reduced sodium soy sauce

Lemon or lime juice

Sprinkled buttered flavor (not made with real butter)

Red pepper flakes

Sprinkle of parmesan cheese (stronger flavor than most cheese)

Sodium-free salt substitute

Jelly or fruit preserves on toast or bagels

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